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Background <p>Delayed fracture healing is a clinically significant complication following proximal femoral nail antirotation (PFNA) fixation in older adults with intertrochanteric femoral fractures. Early identification of patients at risk remains challenging. This prospective observational study investigated whether early postoperative serum NLRP3 levels are associated with delayed radiographic progression.</p> Methods <p>A total of 157 patients undergoing PFNA fixation were enrolled. Serum NLRP3, IL-6, IL-1β, TNF-α, and C-reactive protein were measured on postoperative day 1. Clinical, perioperative, and radiographic data were collected. Fracture healing at 4&#xa0;months was assessed based on radiographic callus formation. Group comparisons, Spearman correlation analysis, receiver operating characteristic (ROC) curves, and multivariate logistic regression were used to evaluate the predictive value of NLRP3.</p> Results <p>Among the 157 patients included, 123 (78.3%) achieved fracture healing and 34 (21.7%) experienced delayed radiographic progression at 4&#xa0;months. Serum levels of NLRP3, IL-6, and IL-1β were significantly higher in the delayed group compared with the healing group. Spearman correlation analysis revealed that serum NLRP3 levels were positively correlated with IL-6 and IL-1β, and negatively correlated with serum albumin. ROC curve analysis demonstrated that NLRP3 exhibited the highest diagnostic performance for delayed radiographic progression, with an area under the curve of 0.831 (95% CI 0.744–0.917). In multivariate logistic regression analysis, higher serum NLRP3 levels, higher IL-6 levels, longer time from injury to surgery, and absence of prefracture independent mobility were independently associated with delayed radiographic progression.</p> Conclusion <p>Early postoperative serum NLRP3 levels were associated with delayed radiographic progression in older adults following PFNA fixation. NLRP3 demonstrated better discriminatory ability than conventional inflammatory markers and remained an independent predictor after adjustment for clinical and perioperative variables. These findings suggest that serum NLRP3 may serve as a useful early indicator to identify patients at risk of delayed radiographic progression.</p>

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Predictive Value of Serum NLRP3 for Delayed Radiographic Progression After PFNA Fixation in Patients with Intertrochanteric Femoral Fractures

  • 期刊论文

  • 发表日期：

    2026年6月3日

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  • Fei Wang,
  • Liqin Wang,
  • Tingting Liu,
  • Qi Zhang,
  • Gongxi Fang,
  • Zhaohong Gao

摘要

Background

Delayed fracture healing is a clinically significant complication following proximal femoral nail antirotation (PFNA) fixation in older adults with intertrochanteric femoral fractures. Early identification of patients at risk remains challenging. This prospective observational study investigated whether early postoperative serum NLRP3 levels are associated with delayed radiographic progression.

Methods

A total of 157 patients undergoing PFNA fixation were enrolled. Serum NLRP3, IL-6, IL-1β, TNF-α, and C-reactive protein were measured on postoperative day 1. Clinical, perioperative, and radiographic data were collected. Fracture healing at 4 months was assessed based on radiographic callus formation. Group comparisons, Spearman correlation analysis, receiver operating characteristic (ROC) curves, and multivariate logistic regression were used to evaluate the predictive value of NLRP3.

Results

Among the 157 patients included, 123 (78.3%) achieved fracture healing and 34 (21.7%) experienced delayed radiographic progression at 4 months. Serum levels of NLRP3, IL-6, and IL-1β were significantly higher in the delayed group compared with the healing group. Spearman correlation analysis revealed that serum NLRP3 levels were positively correlated with IL-6 and IL-1β, and negatively correlated with serum albumin. ROC curve analysis demonstrated that NLRP3 exhibited the highest diagnostic performance for delayed radiographic progression, with an area under the curve of 0.831 (95% CI 0.744–0.917). In multivariate logistic regression analysis, higher serum NLRP3 levels, higher IL-6 levels, longer time from injury to surgery, and absence of prefracture independent mobility were independently associated with delayed radiographic progression.

Conclusion

Early postoperative serum NLRP3 levels were associated with delayed radiographic progression in older adults following PFNA fixation. NLRP3 demonstrated better discriminatory ability than conventional inflammatory markers and remained an independent predictor after adjustment for clinical and perioperative variables. These findings suggest that serum NLRP3 may serve as a useful early indicator to identify patients at risk of delayed radiographic progression.